Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis

Koji Hirano,1 Hidenori Tanaka,2 Kumiko Kato,3 Kaoru Araki-Sasaki4 1Department of Ophthalmology, Fujita Health University Bantane Hospital, Nagoya, Aichi, 454-8509, Japan; 2Department of Ophthalmology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan; 3Department of Ophtha...

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Autores principales:	Hirano K, Tanaka H, Kato K, Araki-Sasaki K
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	culture-proven diagnosis empiric antibiotic therapy herpetic keratitis infectious keratitis topical corticosteroids Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/0f5ca1193b05499c9af26adc5cff83f0
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spelling	oai:doaj.org-article:0f5ca1193b05499c9af26adc5cff83f02021-12-02T14:16:02ZTopical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis1177-5483https://doaj.org/article/0f5ca1193b05499c9af26adc5cff83f02021-02-01T00:00:00Zhttps://www.dovepress.com/topical-corticosteroids-for-infectious-keratitis-before-culture-proven-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Koji Hirano,1 Hidenori Tanaka,2 Kumiko Kato,3 Kaoru Araki-Sasaki4 1Department of Ophthalmology, Fujita Health University Bantane Hospital, Nagoya, Aichi, 454-8509, Japan; 2Department of Ophthalmology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan; 3Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan; 4Department of Ophthalmology, Kansai Medical University, Hirakata, Osaka, 573-1010, JapanCorrespondence: Koji HiranoDepartment of Ophthalmology, Fujita Health University Bantane Hospital, 6-10, Otoubashi 3-cho-me, Nakagawa-ku, Nagoya, Aichi, 454-8509, JapanTel +81-52-321-8171Fax +81-52-322-4734Email kojihira@fujita-hu.ac.jpPurpose: In clinical practice we sometimes encounter patients with severe corneal ulcers who have been treated with topical corticosteroids. This study reviewed the clinical features and visual outcomes of these patients and investigated the background of the prescription of topical corticosteroids.Patients and Methods: The medical records of patients who visited the Cornea Service at Fujita Health University Bantane Hospital and were treated for infectious keratitis from April 2016 to March 2020 were retrospectively reviewed. Patients treated with topical corticosteroids before a culture-proven diagnosis were studied in terms of demographics, best-corrected visual acuity at arrival and at last visit, the clinical course after visit, ocular history, and combination therapy by the previous ophthalmologist.Results: Out of the 200 eyes of 197 patients with infectious keratitis, 14 eyes of 14 patients were treated with topical corticosteroids before a culture-proven diagnosis. All 14 patients were referred, as they had severe keratitis that could not be cured with topical antibiotics and corticosteroids. Based on the culture results, we diagnosed Acanthamoeba keratitis (AK) in six patients, fungal keratitis (FK) in two patients, bacterial keratitis (including a suspected case) in two patients, and unknown cause in four patients. Two patients with AK, FK, and unknown keratitis had unfortunate clinical courses and poor visual outcomes. From the information in the referral letters, at least six of the 14 patients were treated with either acyclovir ocular ointment or valaciclovir tablets, along with topical corticosteroids.Conclusion: Application of topical corticosteroids for keratitis that does not respond to empirical antibiotic therapy is harmful since AK or FK is likely involved in these topical antibiotic-resistant cases. Microbiological evidence, as well as a differential diagnosis of herpetic stromal keratitis, is needed when prescribing topical corticosteroid for the treatment of suspected infectious keratitis.Keywords: culture-proven diagnosis, empiric antibiotic therapy, herpetic keratitis, infectious keratitis, topical corticosteroidsHirano KTanaka HKato KAraki-Sasaki KDove Medical Pressarticleculture-proven diagnosisempiric antibiotic therapyherpetic keratitisinfectious keratitistopical corticosteroidsOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 609-616 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	culture-proven diagnosis empiric antibiotic therapy herpetic keratitis infectious keratitis topical corticosteroids Ophthalmology RE1-994
spellingShingle	culture-proven diagnosis empiric antibiotic therapy herpetic keratitis infectious keratitis topical corticosteroids Ophthalmology RE1-994 Hirano K Tanaka H Kato K Araki-Sasaki K Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis
description	Koji Hirano,1 Hidenori Tanaka,2 Kumiko Kato,3 Kaoru Araki-Sasaki4 1Department of Ophthalmology, Fujita Health University Bantane Hospital, Nagoya, Aichi, 454-8509, Japan; 2Department of Ophthalmology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan; 3Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan; 4Department of Ophthalmology, Kansai Medical University, Hirakata, Osaka, 573-1010, JapanCorrespondence: Koji HiranoDepartment of Ophthalmology, Fujita Health University Bantane Hospital, 6-10, Otoubashi 3-cho-me, Nakagawa-ku, Nagoya, Aichi, 454-8509, JapanTel +81-52-321-8171Fax +81-52-322-4734Email kojihira@fujita-hu.ac.jpPurpose: In clinical practice we sometimes encounter patients with severe corneal ulcers who have been treated with topical corticosteroids. This study reviewed the clinical features and visual outcomes of these patients and investigated the background of the prescription of topical corticosteroids.Patients and Methods: The medical records of patients who visited the Cornea Service at Fujita Health University Bantane Hospital and were treated for infectious keratitis from April 2016 to March 2020 were retrospectively reviewed. Patients treated with topical corticosteroids before a culture-proven diagnosis were studied in terms of demographics, best-corrected visual acuity at arrival and at last visit, the clinical course after visit, ocular history, and combination therapy by the previous ophthalmologist.Results: Out of the 200 eyes of 197 patients with infectious keratitis, 14 eyes of 14 patients were treated with topical corticosteroids before a culture-proven diagnosis. All 14 patients were referred, as they had severe keratitis that could not be cured with topical antibiotics and corticosteroids. Based on the culture results, we diagnosed Acanthamoeba keratitis (AK) in six patients, fungal keratitis (FK) in two patients, bacterial keratitis (including a suspected case) in two patients, and unknown cause in four patients. Two patients with AK, FK, and unknown keratitis had unfortunate clinical courses and poor visual outcomes. From the information in the referral letters, at least six of the 14 patients were treated with either acyclovir ocular ointment or valaciclovir tablets, along with topical corticosteroids.Conclusion: Application of topical corticosteroids for keratitis that does not respond to empirical antibiotic therapy is harmful since AK or FK is likely involved in these topical antibiotic-resistant cases. Microbiological evidence, as well as a differential diagnosis of herpetic stromal keratitis, is needed when prescribing topical corticosteroid for the treatment of suspected infectious keratitis.Keywords: culture-proven diagnosis, empiric antibiotic therapy, herpetic keratitis, infectious keratitis, topical corticosteroids
format	article
author	Hirano K Tanaka H Kato K Araki-Sasaki K
author_facet	Hirano K Tanaka H Kato K Araki-Sasaki K
author_sort	Hirano K
title	Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis
title_short	Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis
title_full	Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis
title_fullStr	Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis
title_full_unstemmed	Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis
title_sort	topical corticosteroids for infectious keratitis before culture-proven diagnosis
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/0f5ca1193b05499c9af26adc5cff83f0
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Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis

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